Y-FIT Ghana: A Study Protocol for a Youth-Led Participatory Approach to Promote Youth-Friendly HIV Self-Testing, Oral and Long-Acting Injectable Pre-Exposure Prophylaxis Uptake in Ghana

The Y-FIT Ghana study protocol outlines a mixed-methods, youth-led participatory approach utilizing Human-Centered Design and Youth Participatory Action Research to co-create and evaluate innovative strategies for improving HIV self-testing and PrEP uptake among adolescents and young adults in Ghana.

The Gist

Imagine the fight against HIV in Ghana as a massive, complex puzzle. For years, health experts have been trying to solve it by designing pieces from the top down—creating rules, clinics, and pamphlets and handing them to young people. But often, these pieces don't fit. Young people find the clinics intimidating, the rules confusing, or the solutions just not "cool" enough to use.

Y-FIT Ghana is a new study that flips the script. Instead of adults handing down solutions, this project asks: "What if the young people holding the puzzle pieces designed the picture themselves?"

Here is a simple breakdown of how this works, using some everyday analogies.

The Problem: The "Locked Door"

In Ghana, young people (ages 15–24) are getting HIV at alarming rates. Why? Because the doors to prevention are locked.

• The Stigma Wall: Going to a clinic feels like walking into a room where everyone is judging you.
• The Confusion Maze: There are great tools available, like HIV Self-Testing (testing yourself at home), Oral PrEP (a daily pill), and Long-Acting Injectable PrEP (a shot that lasts months). But many young people don't know these exist, or they don't know how to get them without getting in trouble or being shamed.

The Solution: The "Youth Innovation Pipeline"

Y-FIT Ghana isn't just a study; it's a three-stage cooking competition where the chefs are the young people, and the dish they are trying to perfect is "How to get our friends to stay HIV-free."

Stage 1: The "Open Call" (The Recipe Contest)

Think of this as a nationwide talent show. The researchers put out a call on social media (TikTok, WhatsApp, Instagram) asking: "If you could invent a way to get your friends to test for HIV or take prevention meds, what would it look like?"

• Young people submit ideas. These could be written plans, short videos, catchy songs, or even sketches.
• It's like a crowdsourcing garage sale for ideas. Anyone can pitch a solution, from a student in Accra to a farmer in a rural village.

Stage 2: The "Innovation Sprint" (The Design Workshop)

About 12 of the best ideas get picked to move forward. These teams fly to Accra for a 2-day "bootcamp" (which they call a "Sprint" to avoid the tired feeling of old-fashioned "athons").

• Imagine a group of friends sitting around a whiteboard with a team of expert mentors (like coaches).
• They take their rough ideas and start prototyping. If someone suggested a "secret club" for testing, they sketch out exactly how that club would work, what the rules are, and how to keep it safe.
• The mentors act like editors, helping them sharpen their ideas so they aren't just cool concepts, but things that could actually work in real life.

Stage 3: The "Bootcamp" (The Final Polish)

The top teams get a one-week intensive training session.

• This is like a masterclass. They learn how to talk to people, how to budget money, how to plan a timeline, and how to make sure their idea doesn't crash and burn.
• They practice their "pitch" (their sales pitch) to stakeholders.
• By the end, they have a ready-to-go plan. It's no longer just a dream; it's a blueprint for a real program.

Why This Matters: The "GPS" Analogy

Usually, health experts try to drive young people to the clinic using a map they drew themselves. But the map is outdated, and the roads are blocked.

Y-FIT Ghana gives the young people their own GPS.

• Because the young people designed the route, they know exactly where the potholes (stigma) are and where the shortcuts (private testing) are.
• They aren't just following orders; they are the architects of their own safety.

The Goal

The study doesn't just want to see if these ideas work; it wants to see if letting young people lead makes the whole system better.

• Feasibility: Can these ideas actually be built?
• Acceptability: Will other young people actually use them?
• Empowerment: Will the young people who designed them feel more confident and skilled?

The Bottom Line

Y-FIT Ghana is a social experiment in trust. It assumes that young people in Ghana aren't the problem; they are the solution. By giving them the tools, the training, and the microphone, the study hopes to unlock a new generation of HIV prevention strategies that are private, cool, and effective—designed by the very people who need them most.

It's about moving from "Here is a pill, take it" to "Here is a problem, let's solve it together."

Technical Summary

1. Problem Statement

Despite global progress in HIV prevention, adolescents and young adults (AYAs) aged 15–24 in sub-Saharan Africa, particularly in Ghana, remain disproportionately affected. In Ghana, this demographic accounts for nearly 29% of new HIV infections despite being a smaller share of the total population. Key barriers to effective prevention include:

• Structural and Social Constraints: Stigma, limited autonomy, economic dependence, and fear of social consequences deter youth from accessing facility-based services.
• Low Awareness and Uptake: Only 25–45% of Ghanaian youth have ever tested for HIV. Awareness of biomedical prevention tools, specifically HIV Self-Testing (HIVST), oral Pre-Exposure Prophylaxis (PrEP), and Long-Acting Injectable PrEP (LAI-PrEP), remains critically low.
• Top-Down Design Failures: Existing prevention strategies often fail to meaningfully involve youth in their design, resulting in interventions that do not align with youth social realities, preferences, or lived experiences.

2. Methodology

The Y-FIT Ghana study employs a mixed-methods, participatory research design grounded in Youth Participatory Action Research (YPAR), Social Innovation Theory, and Human-Centered Design (HCD). The study is guided by Social Cognitive Theory and aims to co-create prevention strategies through a structured three-phase innovation pipeline.

Study Population:

• Target: Ghanaian adolescents and young adults aged 15–24.
• Recruitment: Nationwide digital outreach (social media, WhatsApp) and community-based engagement (schools, youth clubs).
• Inclusivity: Intentional inclusion of diverse gender identities, socioeconomic backgrounds, and geographic regions (urban, peri-urban, rural).
• Ethics: Approved by the University at Buffalo IRB and Ghana Health Service Ethics Review Committee. Parental consent and youth assent are required for participants aged 15–17.

The Three-Phase Innovation Pipeline:

• Phase 1: Crowdsourcing Open Call (12–16 weeks)

  • Activity: A national call for youth-generated ideas to improve HIVST and PrEP uptake.
  • Submission: Participants submit 300–500-word proposals and optional creative materials (videos, infographics) via an online portal or WhatsApp.
  • Selection: A multidisciplinary committee reviews entries based on innovation, feasibility, scalability, and youth-friendliness. Approximately 12 teams/individuals advance.

• Phase 2: HIV Innovation Sprint (2 days, in-person in Accra)

  • Activity: A design workshop (rebranded from "Designathon" to avoid public fatigue with "-thon" events) where selected teams refine concepts.
  • Process: Facilitated by experts in HCD, teams engage in ideation, user journey mapping, and low-fidelity prototyping.
  • Output: Initial prototypes and preliminary implementation concepts.

• Phase 3: Innovation Bootcamp (1 week, hybrid)

  • Activity: Intensive capacity building and apprenticeship.
  • Curriculum: Training in HIV literacy, behavioral insights, implementation science, communication, and budgeting.
  • Process: Iterative refinement of prototypes through peer feedback, role-plays, and small-scale usability testing.
  • Output: Implementation-ready strategies and a public showcase for stakeholders.

Data Collection & Analysis:

• Quantitative: Pre- and post-assessments of HIV knowledge, self-efficacy, leadership capacity, and attitudes toward HIVST/PrEP. Analyzed using R (descriptive statistics, paired t-tests/Wilcoxon tests).
• Qualitative: Semi-structured interviews, focus groups, reflection journals, and mentor observations. Analyzed using NVivo via a hybrid inductive-deductive approach (using the Consolidated Framework for Implementation Research - CFIR).
• Integration: Convergent parallel mixed-methods design to triangulate quantitative outcomes with qualitative narratives.

3. Key Contributions

• Youth-Led Co-Creation: Shifts the paradigm from viewing youth as passive beneficiaries to active co-designers and co-researchers in HIV prevention.
• Contextual Adaptation: Successfully adapts the "Designathon" model to the Ghanaian context by renaming it an "Innovation Sprint" to ensure cultural relevance and credibility.
• Integration of Frameworks: Uniquely combines Social Innovation Theory (collective intelligence) with YPAR (shared ownership) and Implementation Science (feasibility/acceptability metrics).
• Focus on Emerging Technologies: Specifically targets the uptake of newer, less understood modalities like LAI-PrEP and HIVST, addressing the information gap among youth.

4. Expected Results

Note: As this is a study protocol, final outcome data regarding HIV infection rates or PrEP initiation is not yet available. The study is currently in the preparatory/early implementation phase.

• Feasibility & Acceptability: Demonstration that a youth-led social innovation pipeline is a feasible and acceptable method for generating HIV prevention strategies in Ghana.
• Prototype Development: Generation of multiple, contextually grounded, implementation-ready prototypes for HIVST and PrEP delivery.
• Capacity Building: Anticipated gains in participant knowledge, leadership skills, self-efficacy, and research literacy.
• Strategic Insights: Identification of specific barriers and facilitators to youth engagement in HIV prevention, informed by youth narratives and creative outputs.

5. Significance

• Policy Impact: Findings will inform the Ghana Health Service and Ghana AIDS Commission on how to integrate youth-centered strategies into national HIV prevention programming.
• Scalability: The model provides a replicable framework for other low-and-middle-income countries (LMICs) in West Africa and beyond to engage youth in health innovation.
• Implementation Science: Contributes to the evidence base on how participatory processes can be structured to produce sustainable, scalable health interventions.
• Addressing the Epidemic: By aligning prevention tools with youth preferences (privacy, autonomy, convenience), the study aims to directly increase testing rates and PrEP uptake, ultimately reducing new HIV infections among the most vulnerable demographic.